Universal behavioral health screening in the pediatric medical home has the potential to reduce racial and ethnic mental health disparities as standardized tools can systematically identify all children with elevated problem behaviors and referrals can be made. Even when referrals are made, however, mental health services tend to be underutilized, particularly by racial and ethnic minority families and families raising very young children. Therefore, the first aim of the proposed research is to explore, within the context of the medical home, predictors of family follow-up with an on-site behavioral health consultant upon referral. Several factors, including child and family characteristics, parental depression, and parental worry about child behavior, will be explored as predictors (N=2000 parents of children under the age of 5 years). At least part of the disconnect between screening and referral practices and engagement in services may stem from cultural and linguistic barriers between providers and families. Thus, the second aim of the proposed research is to develop and evaluate the feasibility and effectiveness of a cultural competency intervention module to improve pediatric provider use of and comfort with behavioral health screening across racial and ethnic minorities. An intervention module that targets cultural and linguistic barriers to behavioral health screening will be developed and presented to providers in several primary care pediatric sites following a brief screening compliance training. While focusing on broadly defined cultural and linguistic competency, the training will emphasize issues relevant to working with Hispanic families given their growing population and documented disparities in preventive screening, referrals, and mental health care. Extant training programs will be adapted based on individual interviews and focus groups with pediatric providers and parents. It is hypothesized that pediatric provider training will result in improvements in screening completion rates across ethnically and racially diverse families, as well as providers' self- reported knowledge, beliefs, and attitudes toward screening and referral practices with racial and ethnic minorities. PUBLIC HEALTH RELEVANCE: The proposed research will contribute to (a) a better understanding of universal behavioral health screening practices within the pediatric medical home; and (b) ways of ensuring that screening practices serve their intended purpose of linking families, particularly underserved racial and ethnic minority families, with needed services. This research will help to elucidate barriers to behavioral health screening and referral practices within the pediatric medical home and explore avenues for improving these practices and reducing racial and ethnic disparities in mental health care.